A study in JAMA Cardiology compares accessibility, cost and quality of coronary procedures at Department of Veterans Affairs (VA) hospitals and non-VA hospitals.

They posed the question: “Does the Veterans Affairs Community Care (CC) Program, which allows veterans to receive care at non–Veterans Affairs sites, increase the accessibility and value of their elective coronary revascularization procedures?

They found: “Among 13 ,237 elective percutaneous coronary interventions and 5,818 elective coronary artery bypass graft procedures in this veteran cohort study, use of the Community Care Program reduced aggregate veteran travel distance for revascularization. Community Care Program hospitals had higher mortality and costs for percutaneous coronary intervention and had equivalent mortality and lower costs for coronary artery bypass graft surgery.

“The higher mortality of CC-provided PCIs was not necessarily due to lower quality of care at CC hospitals,” the authors wrote. “Other possible factors include delay in making care arrangements, incomplete coordination of care between VA and CC hospitals, or failure to refill medications prescribed by CC clinicians. These are obvious areas for future research and quality improvement efforts.”

The study reaffirmed earlier studies showing that quality of VA care is similar to non-VA care. The authors suggested that since many VA hospitals perform these coronary procedures below recommended minimum annual procedure volumes, increasing capacity at high-performing VA hospitals to improve outcomes would make more sense than expanding access at non-VA community facilities.